A Simple Device to Detect Concussions

The start this month of high school and college football seasons across the country renews concerns about the issue of repeated head impacts and how to manage or, preferably, avoid concussions. Unfortunately, the resources to deal with the problem remain limited. Newly released, state-of-the-art football helmets, for instance, may measure how much force each player’s head is absorbing and relay that data via telemetry to trainers on the sidelines, but at $1,500 or so per helmet, they are unattainable for most teams.

Which is why a study published recently in The British Journal of Sports Medicine is so appealing. Eminently practical, it offers a means by which any team, no matter how small or cash-strapped, can assess the likelihood of one of its players having sustained an on-field concussion. It also celebrates a nifty, D.I.Y., MacGyver-ish sensibility rarely seen in our technology-obsessed times.

The study’s authors began with the simple idea that, to manage sports-related concussions, “you need to be able to quickly and easily assess” whether a given player has actually sustained one, said Steven P. Broglio, director of the University of Michigan’s NeuroSport Research Laboratory and co-author of the study. Not every head impact results in a concussion.

One means of assessing concussion status, Dr. Broglio continued, is to look at a player’s reaction time, since it is known to increase immediately after a concussion. A variety of scientifically validated tools exist to measure players’ reaction times, but most require a computer and sophisticated software, and are not practicable on the sidelines or in the budgets of many teams.

So Dr. Broglio and his colleague Dr. James Eckner, an assistant professor of medicine at the University of Michigan, set out to develop an inexpensive means of measuring reaction time. After some noodling, Dr. Eckner came up with the idea of attaching a hockey puck via adhesive to a long wooden dowel, and marking centimeters in ink along the length of the dowel.

Photo

Dr. James T. Eckner of the University of Michigan administering the puck-and-dowel ruler test to check for a possible concussion.Credit Dr. Steven Broglio

To use the device, an evaluator simply holds it in front of an athlete who is seated at a table with one arm resting on the surface and his hand at the table’s edge. The evaluator aligns the puck with the bottom of the athlete’s hand and lets go. The athlete catches the falling stick. The evaluator marks where his hand lands, and, voila, a coach or trainer has a baseline measure of someone’s reaction time. Theoretically, should a player later be suspected of having sustained a concussion, the trainer could pull out the dowel-puck, repeat the test, and, if the player’s reaction time were slower, conclude that he or she likely was concussed.

But that idea required validation. So last year, Dr. Eckner, Dr. Broglio and their colleagues rigorously tested the reliability of their homemade reaction-time tool. They first used the dowel to measure pre-season reaction times of collegiate and high school football, soccer and hockey players. (The researchers determined actual reaction times by plugging the centimeter measures into mathematical formulas.)

Then they waited, slightly ghoulishly, for the same athletes to become injured. The athletes obliged. During the season after baseline measurements were collected, 28 male and female athletes were diagnosed with concussions. Knowing that these athletes had sustained concussions, the scientists asked them to re-take the dowel test, in each case within at least 48 hours of the head injury.

They also asked another 28 of the originally tested athletes to retake the test, as controls.

The dowel-puck turned out to be a remarkably reliable indicator of a concussion. Those athletes who had sustained the injury were significantly slower now to grasp the dowel, often requiring a full second more. The un-concussed athletes, on the other hand, displayed equivalent or, in many cases, faster reaction times on their re-test.

The outcome of the testing was so consistent that even its developers seemed a bit taken aback. This “single, five-minute test” requiring “equipment costing less than five U.S. dollars” had “comparable test characteristics to other concussion assessment tools, including lengthier, computerized neuropsychological test batteries.”

The practical implications of this finding are obvious. Even the least handy of coaches or trainers can cobble together a makeshift ruler using a puck and dowel, use it to determine athletes’ baseline reaction times, and re-test any player who is suspected of sustaining a concussion. The test reliably can be administered on the sidelines immediately after a hard hit, Dr. Broglio said, and if a player shows a longer reaction time, no matter how slight the increase, the player should almost certainly be removed from play and seen by a doctor.

“We’re not saying” that the dowel test is definitive, Dr. Broglio said. Concussions remain highly individualized, differing in severity and presentation from player to player. “The more tests that are used to assess” a player’s brain health, he said, “the better.” But the dowel measurement has the advantage of being readily available to any team, he points out, no matter how small their resources, if their will to protect their players is sufficiently ample.